To wonder why A&E seems to be designed to be the worst possible place you could possibly be when ill?

Reasons for the design of the a and e waiting room?

Well firstly you have the actual building. This room adjoins many rooms ie. Triage, admin, curtain rooms, private rooms, corridors, clean and dirty service routes and sluices, toilets, access to wards etc. Designing a hospital as a whole so everything is actually adjacent to other things it needs is a nightmare in itself.

Then the actual waiting room. They need to be designed for all events. So if a 30 stone man collapses can we get a hoist in here to all locations. Really you’re not designing for the average person. You’re designing for the most impossible situations.

The main thing which makes them dire is the seating. But I challenge anyone on this thread to propose a chair suitable for 24/7 365 use, which is suitable for a single person (so you don’t feel like your sitting on someone else’s chair). Fixed, yet also moveable and stackable. And cleanable in the event someone pisses on it, vomits on it or bleeds on it.

It is a great place to catch disease yes, this is what always annoys me about healthcare establishments, including the GP. Mixing up the injured with the infectious so the injured end up also infected. I once heard someone say that the best place to get ill in any town is the GP. Mine had no open windows. I still feel bad about all the elderly in the waiting room with appointments for their hypertension/arthritis while I was waiting with a chest infection so bad that I sometimes couldn't breathe. Surely abundant ventilation is only common sense. I have also waited in A&E with a kid with broken foot bone(s) along with people with stomach bugs so bad they have brought along their own sickbowls. Do other countries have somewhere for the clearly infectious to wait?

Yes this is one of the huge issues. Far more people there than it’s designed for.

They really are awful places. I had to attend twice last month as I miscarried and had 2 severe hemorrhages. I was sent to a+e by the early pregnancy unit and they phoned ahead so they were expecting me. I could barely stand, felt dizzy and sick and still was expected to stand in the queue. Staff were desperately trying to clear seats for patients as everyone seemed to have brought numerous family members with them. People were collapsing and throwing up all over the place. The alarm bell rang at least 4 times in the 2 hours I was waiting to be admitted due to patients collapsing. There were people on trollies all over the corridor and also at the back of the waiting room.

Our A+E also has no windows and they are doing really loud building works outside that seems to consist of drilling, hammering and digging up concrete for hours a day. So that's thrilling to listen to. The canteen is shut and the tiny little shop only sold crisps and chocolate bars. The vending machines are half empty. The parking situation is dire.

They really are not designed for the volume of people who are using them. In our area they have built on nearly every spare inch of land but have not upgraded the services. Drs appointments are a months wait, or battle for an on the day appointment, the online system opens at 8, the phones at 8.30 at 8.31 you will be number 80 in the queue. Appointments are gone by 9am. All the Drs surgeries now have a message on their answer phones from 9.15am every morning telling people there are no appointments and to attend A+E.

The last few times I have gone, there seems to be numerous care home residents in A+E with a member of care home staff. Lots seemed to have fallen. I was chatting to one of the staff members and they were there for a medication review, the care home no longer had a visit from the Drs surgery and the surgeries solution was to send all patients from the care home needing medication reviews to A+E.

This! Sadly it’s also true with other spaces supposedly ‘designed’ for the sick or disabled. The whole thing needs revamping because people are being harmed :(

I agree. We get treat like cattle

I am terminally ill and have to go to a&e perhaps a couple of times a year
It is actually the pits of hell 👿

It is a great place to catch disease Ours is often filthy dirty with excrement smeared on the walls and or sick on the floors You may be sitting next to someone who is puking in to a cardboard bucket

A great place to get assaulted whilst sitting there Ours always seems to attract drunks and trouble makers and the last time i was there, someone came in with a cheap bottle of wine and was screaming and shouting, and despite two huge security guard watching, no one removed him. He wasn't there for an illness he just came in to shout and go for a shit in the middle of the floor. Eventually he forcefully threw his wine bottle on the floor - resulting in three people including myself needing stiches

Basic amenities no where nearby to get a drink- whatsoever. There is a canteen at the other side of the hospital which is at least a five min walk - if you leave the a&e dept., you will get shunted to the back of the queue - (last time i was there, i was in for a 14 hour sit on a hard plastic chair) . If you ask how long it may be (so you can work out if you can make it there and back intime) they will say they dont know and have no way of finding out

I think they shouldn't allow family members - as they are taking seats away from the unwell. My A&E constantly make announcements, if you are not the patient please leave, however despite this and the doctors coming out and shouting it, you will always get some who ignore.

What reasons, especially related to A&E? Is there any consideration given to the walking wounded?

Agree. I collapsed at work when 12w pregnant & tried 111/ GP but everything sent me to urgent care, who then sent me to A&E.

I was so dizzy, faint & confused & the room was about 30° (outside was about 15) and incredibly noisy (eg a TV that nobody could hear, names being shouted, people kicking off) There were no chairs & nowhere to sit on the floor. had to go & sit on the toilet because I felt myself fainting agajn. I then obviously missed being called & was put to back of queue. It was horrendous. Frail elderly main with nothing covering him sitting in a doorway on the floor. It was completely 3rd world.

I think the separate urgent care and minor injuries units are brilliant and should be far more well known and used. I had no idea one existed in the next town until someone mentioned it by chance. I've taken my kids to the main A&E a couple of times with suspected broken fingers, wrists etc and had v long waits in unpleasant conditions, well into the night in one case when they closed the paed A&E and transferred us and we went to the back of the queue. The MI and UC units tend to be much less busy and could take a lot of pressure of real emergencies.

A and E is a nightmare, I had an aunt nearly die after refusing to go because of the way she was treated last time she was in. She was screaming in pain and still would not go. She relented after 4 hours. Other people do not make it easy either.

Last time I was in A and E with my child there was 7 family members taking up seats for 1 child. They did not get up when another parent asked if they could have a seat so their obviously sick child could sit on their knee.

The staff were asked to do something about it but didn’t (prob scared of them kicking off)
They then all vacated to accompany the
child to x ray. They seemed very put out then they got back to the waiting room and found people sat in the chairs they had been sitting on. Funny enough 6 of them left including the dad when the choice was sitting on the floor.

If space were not such an issue then it would be ideal to have a triaged waiting area. So for those clearly needing a dressing on a cut or something waiting area 1 normal chairs and so on, then for those with suspected broken ankle or more serious problems quiet room with big recliner chairs.
Problem is A&E is not seperated from minor injuries as there isn't one where I live so it's a catch all for all out of hours issues.
So you can be sitting next to the child with a bit of a sprained ankle and the woman who might be having a heart attack.
I don't find the staff triage very well either once took my DD who was 13 with severe abdominal pain, took ages to see her until a nurse realised she was pediatrics and rushed her through. It was 3am by then.
She said oh you are tall for your age we thought you were an adult!

Loved working there but whoever invented those narrow, labyrynthine corridors around which we had to push trolleys clearly didn't think of the staff either!

It’s a long list of complaint. Honestly I get it. These places are often hell on earth.

But we don’t visit them that frequently. Or certainly not as frequently as the consultants who work there, or the staff routes through the hospital. So why shouldn’t the consultant who has to walk a route 100 times a day scurrying about have an office located in a convenient place. And why shouldn’t the staff use a shorter internal route to X-ray if it’s available for them (ie. Probably through service area). Same for the carpark!

As you say we can get you a wheelchair and a volunteer to solve your problem. We can’t clone the consultants because they are stuck traversing a corridor for the 99th time that day.

I wonder how well that even works anymore, if there are no other options.

A colleague of mine was having trouble with her knee. It was gradually (over weeks, not a sudden thing) becoming more and more painful to the point she really struggled to walk. She hadn't had an accident, it wasn't broken, but there was obviously something wrong.
The GP wouldn't see her face to face, just said go to A&E. She didn't want to, partly because she didn't think she needed to because it didn't seem like an emergency, and partly because she knew it would be a horrible wait in a horrible environment. But she went in the end because however much you discourage people from A&E, if they have no other options, they'll end up there eventually. Her GP was just refusing to see her. What other option did she have?

I agree with the OP.
I was in A&E for 7 hours, back in January, awaiting some help after a fall (turned out that I'd broken two ribs). I was struggling to breathe and every movement hurt. I was sat on a hard backed chair for that full 7 hours with nothing more than 2 paracetamol offered during the initial triage. There was a single hot drinks machine, the output of which looked like dirty water, but it tripped the electrics twice during my time there so they ended up turning it off. There were no other drinks or food facilities without walking outside the building, up a hill and into another hospital building (not possible really as you'd likely miss being called through and I hurt to much anyway). There was no water cooler or anything like that. So, I sat in pain for 7 hours with nothing to drink. I felt absolutely rotten when I was sent on my way a few hours later.

I work on the ambulance, our local A&E does this as well! But if you're well enough to make your own way to and from A&E then likelihood is whilst we certainly might take you back to A&E (after you've waited 2-3 hours for our arrival), you'll be well enough for self handover - we just point you to reception there's no handover to clinical staff at the hospital just "reception is through there to book in, all the best".

Handover times from ambulance to A&E are so extended now that we'll normally only wait with you if you're so unwell actually couldn't sit in a chair - honestly as horrible as it is if you made it to and from A&E then it's quite unlikely (but I agree certainly not impossible) that this will be the case. The other reason is that you lack the capacity to give your own details/history to staff.

I don't know why the A&Es still do it, by going home and coming back by ambulance liklihood is you'll be back in reception just 3-5 hours will have past. It's awful when people realise/they rightfully upset. But ultimately we can't wait with you for comfort reasons as there's a massive queue of people waiting for ambulances out there who are also waiting hours but some of them will be barely breathing, elderly with multiple fractures from falls, collapsed from chest pain unable to stand, had a stroke. There're all out there waiting for us so if you can walk and talk the guidance for ambulance staff now is point them to reception, clean the ambulance and get back on the road.

Nz too!

If it was a pleasant comfortable place to wait then more people would attend so I suppose it's a way of cutting out the time wasters.

I spent a Saturday night in A&E with what turned out to be a retinal tear, was eventually seen by on call eye consultant and laser repair done the next morning so all worth it.

The wait was uncomfortable but fascinating as could hear every word when people came in to register with receptionist, lots of drunks with injuries, a limping woman complained that her friend disrespected her so she kicked her in the head and fell over!

@Bellamari annoyingly it can't be done privately

I mean it probably could if I was celebrity money rich but NHS originally sent me via Spire and they won't touch me
It needs a bowel surgeon as well as a specialist endometriosis surgeon because it's so advanced

Thanks to the doctor that told me nearly a decade ago when I suggested I might have it "well if you don't want the pill we can't do anything else"

Like when?! I can remember hours waiting before the current ( last) Tory govt got into power. It may not have been as long as now but certainly not 90 mins Was working with the elderly and often spent majority of an 8/9 hour shift at hospital with someone who had a fall.

Good design of A&E is so important. It should have at least 2 waiting areas, so the young and elderly attendees, don’t have to wait in an area where drunks are swearing and scuffling. My dd had to sit and breast feed her dd, while police were trying to deal with drunk and drugged patients in the same small area (should mention she had to sit on the floor, while the aforementioned patients were taking over the waiting room). There should be a private area, where patients can book in online (if they are able too) and are triaged, so no other patients can hear what is wrong with them.

However A&E isn’t the only area to be considered when designing hospitals. Other things that should be considered, is where the clinic bays, and more especially, where X-ray is. Our (newish) hospital has X-ray almost as far away as possible, but has a back way in and out, which is less than half the distance patients are expected to walk to get there and back.

Then next should be where the wards are, again in my hospital, they are so far away (think down a long atrium, then a long corridor and another shorter one before reaching the ward entrance, then if you’re unlucky right down to the end of the ward). However the admin and executive’s offices are up one flight of stairs, or a short lift journey,at the entrance to the hospital! Things like this mean that people, like myself, have to rely on volunteers to wheelchair them. If it’s busy you have to wait in turn to be taken to where you want to go to, or try to walk there, so you’re not late for your appointment. When my late husband was in hospital, he was the furthest away it was possible to be, so I struggled to even visit him.

Another thing to look at is the size of the car park. Again, our hospital car park is too small to handle all those travelling by car, which you need to do, (especially if you are disabled like myself), as it is quite a distance from the nearest town. If you need a disabled space, good luck in finding one. Staff aren’t supposed to park in the main car park, but they do, taking up over half the spaces. Who can blame them though, the executives have their own named spaces in the main car park.

It was already not fit for purpose, before it even opened. It was so bad that the old hospital had to be kept to use for several specialities, as well as having to re-open one of the wards and last winter a second ward. The number of staff that applied to be transferred back there (think 30+, for 1 healthcare support position) showed how much even the staff disliked the new hospital.

So not a french citizen then? Friends of mine who are french citizens have majority of healthcare covered through contributions/ insurance they take from wages

My sister subscribes to a medical app. She can make an appointment to see a doctor via Zoom within 24 hours. They can’t do repeat prescriptions or anything that needs an in person examination. But they can give one off prescriptions for minor things, like antibiotics or creams, and they can give advice, and they can do referrals to specialists.

I needed to see a neurologist, the NHS GP said the waiting time was about a year. So I got my credit card out and in exchange for £250 the waiting time magically dropped to three weeks, in a plush little private clinic where I was greeted by a member of staff and given coffee while I waited in a proper waiting room with leather chairs and coffee tables.

It’s a two tier system and money talks. The rich (or those who can stretch to it) get treatment quickly. Everyone else has to wait months or years for treatment, getting worse or possibly dying while waiting. I know a number of people who’ve sold their tv or jewellery etc to see a private specialist because the NHS said they’d have to wait for a year. My neighbour sold his motorbike to get a private autism diagnosis for his wife because they were saying she’d have to wait four years.